DOI QR코드

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Carbohydrate Antigen 19-9 Levels Associated with Pathological Responses to Preoperative Chemoradiotherapy in Rectal Cancer

  • Yeo, Seung-Gu (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Kim, Dae Yong (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Kim, Tae Hyun (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Kim, Sun Young (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Baek, Ji Yeon (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Chang, Hee Jin (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Park, Ji Won (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center) ;
  • Oh, Jae Hwan (Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center)
  • 발행 : 2014.07.15

초록

Purpose: To investigate whether pretreatment serum carbohydrate antigen 19-9 (CA 19-9) levels are associated with pathological responses to preoperative chemoradiotherapy (CRT) in patients with rectal cancer. Materials and Methods: In total, 260 patients with locally advanced rectal cancer (cT3-4NanyM0) who underwent preoperative CRT and radical surgery were analyzed retrospectively. CRT consisted of 50.4 Gy pelvic radiotherapy and concurrent chemotherapy. Radical surgery was performed at a median of 7 weeks after CRT completion. Pathological CRT response criteria included downstaging (ypStage 0-I) and ypT0-1. A discrimination threshold of CA 19-9 level was determined using a receiver operating characteristics analysis. Results: The median CA 19-9 level was 8.0 (1.0-648.0) U/mL. Downstaging occurred in 94 (36.2%) patients and ypT0-1 in 50 (19.2%). The calculated optimal threshold CA 19-9 level was 10.2 U/mL for downstaging and 9.0 U/mL for ypT0-1. On multivariate analysis, CA 19-9 (${\leq}9.0U/mL$) was significantly associated with downstaging (odds ratio, 2.089; 95% confidence interval, 1.189-3.669; P=0.010) or ypT0-1 (OR, 2.207; 95%CI, 1.079-4.512; P=0.030), independent of clinical stage or carcinoembryonic antigen. Conclusions: This study firstly showed a significant association of pretreatment serum CA 19-9 levels with pathological CRT responses of rectal cancer. The CA 19-9 level is suggested to be valuable in predicting CRT responses of rectal cancer cases before treatment.

키워드

참고문헌

  1. Callender GG, Das P, Rodriguez-Bigas MA, et al (2010). Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer. Ann Surg Oncol, 17, 441-7. https://doi.org/10.1245/s10434-009-0735-7
  2. Charlton ME, Lin C, Jiang D, et al (2013). Factors associated with use of preoperative chemoradiation therapy for rectal cancer in the cancer care outcomes research and surveillance consortium. Am J Clin Oncol, 36, 572-9. https://doi.org/10.1097/COC.0b013e318261082b
  3. Chen CC, Yang SH, Lin JK, et al (2005). Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer? J Surg Res, 124, 169-74. https://doi.org/10.1016/j.jss.2004.08.013
  4. Collette L, Bosset JF, den Dulk M, et al (2007). Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European organisation for research and treatment of cancer radiation oncology group. J Clin Oncol, 25, 4379-86. https://doi.org/10.1200/JCO.2007.11.9685
  5. Dou X, Wang RB, Meng XJ, et al (2014). PDCD4 as a predictor of sensitivity to neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients. Asian Pac J Cancer Prev, 15, 825-30. https://doi.org/10.7314/APJCP.2014.15.2.825
  6. Dou X, Wang RB, Yan HJ, et al (2013). Circulating lymphocytes as predictors of sensitivity to preoperative chemoradiotherapy in rectal cancer cases. Asian Pac J Cancer Prev, 14, 3881-5. https://doi.org/10.7314/APJCP.2013.14.6.3881
  7. Duffy MJ (1998). CA 19-9 as a marker for gastrointestinal cancers: a review. Ann Clin Biochem, 35, 364-70. https://doi.org/10.1177/000456329803500304
  8. Guillem JG, Ruby JA, Leibold T, et al (2013). Neither FDG-PET Nor CT can distinguish between a pathological complete response and an incomplete response after neoadjuvant chemoradiation in locally advanced rectal cancer: a prospective study. Ann Surg, 258, 289-95. https://doi.org/10.1097/SLA.0b013e318277b625
  9. Kim DW, Kim DY, Kim TH, et al (2006). Is T classification still correlated with lymph node status after preoperative chemoradiotherapy for rectal cancer? Cancer, 106, 1694-700. https://doi.org/10.1002/cncr.21794
  10. Landry JC, Feng Y, Cohen SJ, et al (2013). Phase 2 study of preoperative radiation with concurrent capecitabine, oxaliplatin, and bevacizumab followed by surgery and postoperative 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX), and bevacizumab in patients with locally advanced rectal cancer: ECOG 3204. Cancer, 119, 1521-7. https://doi.org/10.1002/cncr.27890
  11. Lee JH, Kim SH, Jang HS, et al (2013). Preoperative elevation of carcinoembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision: a multi-institutional analysis in an Asian population. Int J Colorectal Dis, 28, 511-7. https://doi.org/10.1007/s00384-012-1584-6
  12. Lee JW, Lee JH, Kim JG, et al (2013). Comparison between preoperative and postoperative concurrent chemoradiotherapy for rectal cancer: an institutional analysis. Radiat Oncol J, 31, 155-61. https://doi.org/10.3857/roj.2013.31.3.155
  13. Lee WC, Yusof MM, Lau FN, Phua VC (2013). Preoperative long course chemoirradiation in a developing country for rectal carcinoma: Kuala Lumpur hospital experience. Asian Pac J Cancer Prev, 14, 3941-4. https://doi.org/10.7314/APJCP.2013.14.6.3941
  14. Lin PC, Lin JK, Lin CC, et al (2012). Carbohydrate antigen 19-9 is a valuable prognostic factor in colorectal cancer patients with normal levels of carcinoembryonic antigen and may help predict lung metastasis. Int J Colorectal Dis, 27, 1333-8. https://doi.org/10.1007/s00384-012-1447-1
  15. Locker GY, Hamilton S, Harris J, et al (2006). ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol, 24, 5313-27. https://doi.org/10.1200/JCO.2006.08.2644
  16. Maas M, Nelemans PJ, Valentini V, et al (2010). Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol, 11, 835-44. https://doi.org/10.1016/S1470-2045(10)70172-8
  17. Malik I, Hussein F, Bush D, et al (2010). A phase I study of capecitabine, irinotecan, celecoxib, and radiation as neoadjuvant therapy of patients with locally advanced rectal cancer. Am J Clin Oncol, 33, 242-5.
  18. Moon SH, Kim DY, Park JW, et al (2012). Can the new American joint committee on cancer staging system predict survival in rectal cancer patients treated with curative surgery following preoperative chemoradiotherapy? Cancer, 118, 4961-8. https://doi.org/10.1002/cncr.27507
  19. Nozoe T, Rikimaru T, Mori E, Okuyama T, Takahashi I (2006). Increase in both CEA and CA19-9 in sera is an independent prognostic indicator in colorectal carcinoma. J Surg Oncol, 94, 132-7. https://doi.org/10.1002/jso.20577
  20. Park IJ, You YN, Agarwal A, et al (2012). Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol, 30, 1770-6. https://doi.org/10.1200/JCO.2011.39.7901
  21. Passoni P, Fiorino C, Slim N, et al (2013). Feasibility of an adaptive strategy in preoperative radiochemotherapy for rectal cancer with image-guided tomotherapy: boosting the dose to the shrinking tumor. Int J Radiat Oncol Biol Phys, 87, 67-72. https://doi.org/10.1016/j.ijrobp.2013.05.004
  22. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD (2010). Postoperative complications following surgery for rectal cancer. Ann Surg, 251, 807-18. https://doi.org/10.1097/SLA.0b013e3181dae4ed
  23. Reiter W, Stieber P, Reuter C, et al (2000). Multivariate analysis of the prognostic value of CEA and CA 19-9 serum levels in colorectal cancer. Anticancer Res, 20, 5195-8.
  24. Rodel C, Arnold D, Becker H, et al (2010). Induction chemotherapy before chemoradiotherapy and surgery for locally advanced rectal cancer: is it time for a randomized phase III trial? Strahlenther Onkol, 186, 658-64. https://doi.org/10.1007/s00066-010-2194-2
  25. Taylor FG, Quirke P, Heald RJ, et al (2011). Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg, 253, 711-9. https://doi.org/10.1097/SLA.0b013e31820b8d52
  26. Yeo SG, Kim DY, Kim TH, et al (2010). Local excision following pre-operative chemoradiotherapy-induced downstaging for selected cT3 distal rectal cancer. Jpn J Clin Oncol, 40, 754-60. https://doi.org/10.1093/jjco/hyq062
  27. Yeo SG, Kim DY, Kim TH, et al (2010). Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg, 252, 998-1004. https://doi.org/10.1097/SLA.0b013e3181f3f1b1
  28. Yoon SM, Kim DY, Kim TH, et al (2007). Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys, 69, 1167-72. https://doi.org/10.1016/j.ijrobp.2007.04.047
  29. Yu CS, Yun HR, Shin EJ, et al (2013). Local excision after neoadjuvant chemoradiation therapy in advanced rectal cancer: a national multicenter analysis. Am J Surg, 206, 482-7. https://doi.org/10.1016/j.amjsurg.2013.01.042
  30. Zeestraten EC, Kuppen PJ, van de Velde CJ, Marijnen CA (2012). Prediction in rectal cancer. Semin Radiat Oncol, 22, 175-83. https://doi.org/10.1016/j.semradonc.2011.12.005

피인용 문헌

  1. Two Cases of Primary Lung Cancer with Elevated CA19-9 Levels vol.55, pp.2, 2015, https://doi.org/10.2482/haigan.55.93
  2. Clinical utility of pretreatment prediction of chemoradiotherapy response in rectal cancer: a review vol.8, pp.1, 2017, https://doi.org/10.1007/s13167-017-0082-x